AB0794 Hopelessness in patients with ankylosing spondylitis
Authors: A. Komac, N. Gokcen, A. Yazici, A. Cefle
Journal: Annals of the Rheumatic Diseases (2022)

Background Ankylosing spondylitis (AS) is a chronic inflammatory disease leading to loss of function that is strongly related to impaired psychological status. Therefore, depression and anxiety are frequently investigated in these patients (1). However, hopelessness, regarded as a valuable psychological factor characterized by negative expectations and negative emotional states, was not well studied in AS patients(2). Objectives The aim of the study is to investigate the frequency of hopelessness in patients with AS and its relationship with clinical parameters and disease activity indices. Methods The study was designed as a prospective cross-sectional study. 113 AS patients were included in the study. Demographic data, clinical variables, laboratory results were recorded. Disease activity (ASDAS-CRP and ASDAS-ESR), patients’ functionality (BASFI, BASMI), enthesitis (Leeds enthesitis index) and quality of life (SF-36) were assessed. Hopelessness was evaluated by Beck hopelessness scale (BHS). The relation of BHS scores with the clinical variables was assessed. The strength of the correlations were regarded as very weak(0–0.19), weak(0.2–0.39), moderate(0.40–0.59), strong(0.6–0.79) and very strong(0.8-1). Multiple linear regression analysis was performed to find the association between BHS scores and other clinical variables. Results Minimal, mild, moderate, and severe hopelessness were observed in 46 (40.7%), 36 (31.9%), 22 (19.5%), and 9 (8.0%) patients, respectively. Disease duration (p=0.025), ASDAS-CRP (p=0.033), ASDAS-ESR (p=0.015), visual analogue scale (p=0.030), all SF-36 subscales (all p&lt;0.025), BASFI (p=0.024), and BASMI (p=0.009) were statistically different among the groups. BHS scores were higher in patients with high and very high disease activity (p=0.027) (in pairwise comparison, inactive disease vs. high disease activity, p=0.035) (Figure 1). BHS scores showed weak correlation with ASDAS-CRP, ASDAS-ESR, visual analogue scale, BASMI, Leeds enthesitis index, and BASFI. Moreover, negative moderate correlations were detected between BHS scores and SF-36 subscales except social functioning and body pain, which were found weak correlation. In multiple linear regression analysis, BASMI-maximal intermalleolar distance, SF-36 energy, SF-36 mental health, and SF-36 general health were found associated with BHS scores (Table 1). Table 1. Multiple linear regression analysis to find predictors related to the Beck hopelessness scale scores B 95% CI p ASDAS-CRP -0.063 (-1.939) to 1.282 0.687 VAS -0.085 (-0.722) to 0.396 0.564 BASMI Lateral spinal flexion 0.311 (-0.299) to 1.479 0.191 Tragus to wall distance 0.157 (-0.404) to 1.602 0.239 Modified Schober 0.298 (-0.114) to 1.368 0.096 Maximal intermalleolar distance 0.228 0.076 to 0.557 0.010 Cervical rotation 0.092 (-0.665) to 1.085 0.635 Total -0.730 (-5.572) to 1.042 0.177 SF-36 Physical function -0.024 (-0.056) to 0.046 0.840 Role physical -0.114 (-0.046) to 0.017 0.364 Role emotional -0.019 (-0.029) to 0.024 0.870 Energy/fatigue -0.283 (-0.125) to (-0.005) 0.035 Mental health -0.306 (-0.142) to (-0.022) 0.008 Social functioning 0.022 (-0.033) to 0.041 0.822 Body pain 0.182 (-0.018) to 0.086 0.192 General health -0.344 (-0.125) to (-0.030) 0.002 BASFI -0.085 (-0.606) to 0.248 0.408 Figure 1. Beck hopelessness scale scores according to disease activity subgroups Conclusion Higher level of hopelessness is strongly related to higher disease activity in AS patients. Furthermore, higher BHS scores are negatively correlated with SF-36 subscales. Especially, lower energy and impaired mental health are associated with higher level of hopelessness. References [1]Zhang L, Wu Y, Liu S, Zhu W. Prevalence of Depression in Ankylosing Spondylitis: A Systematic Review and Meta-Analysis. Psychiatry Investig . 2019;16(8):565-574. doi:10.30773/pi.2019.06.05 [2]Balsamo M, Carlucci L, Innamorati M, Lester D, Pompili M. Further Insights Into the Beck Hopelessness Scale (BHS): Unidimensionality Among Psychiatric Inpatients. Front Psychiatry . 2020;11:727. Published 2020 Jul 31. doi:10.3389/fpsyt.2020.00727 Disclosure of Interests None declared